title: Successful treatment of hemodynamic compromise caused by antibody-mediated and cellular rejection in a recipient 12 years after heart transplantation.
abstract: Heart transplantation (HTx) is an established therapy for stage D heart failure due to recent advances in immunosuppressive regimens. However, antibody-mediated rejection remains an unsolved problem because of its refractoriness to standard immunosuppressive therapy with high mortality and graft loss. We experienced a 16-year old patient with hemodynamic compromise caused by both cellular and antibody-mediated rejection 12 years after HTx. The rejection was refractory to repeated steroid pulse treatment, intravenous immunoglobulin administration, and intensifying immunosuppression including addition of everolimus. Eventually, she was successfully treated with repeated plasma exchange accompanied by a single administration of the anti-CD20 monoclonal antibody rituximab.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medicine, the University of Tokyo.
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Imamura
authors.forename: Koichiro
authors.initials: K
authors.lastname: Kinugawa
authors.forename: Naoko
authors.initials: N
authors.lastname: Kato
authors.forename: Yukie
authors.initials: Y
authors.lastname: Kagami
authors.forename: Miyoko
authors.initials: M
authors.lastname: Endo
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Kaneko
authors.forename: Shun
authors.initials: S
authors.lastname: Minatsuki
authors.forename: Hironori
authors.initials: H
authors.lastname: Muraoka
authors.forename: Toshiro
authors.initials: T
authors.lastname: Inaba
authors.forename: Hisataka
authors.initials: H
authors.lastname: Maki
authors.forename: Masaru
authors.initials: M
authors.lastname: Hatano
authors.forename: Kent
authors.initials: K
authors.lastname: Doi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yao
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Takazawa
authors.forename: Minoru
authors.initials: M
authors.lastname: Ono
authors.forename: Shunei
authors.initials: S
authors.lastname: Kyo
authors.forename: Issei
authors.initials: I
authors.lastname: Komuro
mesh_terms: D000293:Adolescent; D058846:Antibodies, Monoclonal, Murine-Derived / Q000627:therapeutic use; D002675:Child, Preschool; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy*; D006333:Heart Failure / Q000209:etiology*; D016027:Heart Transplantation; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use; D010951:Plasma Exchange; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D007155:Immunologic Factors; D000069283:Rituximab